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Merkel cell carcinoma (MCC) is a malignant neuroendocrine tumor. Metastasis or lymph node spread is often detected at diagnosis. We performed a descriptive, retrospective study of patients diagnosed with MMC at Hospital Universitario Fundación Alcorcón in the Community of Madrid, Spain between January 1998 and December 2018. Eleven patients (7 men [63%] and 4 women [36%]; mean age, 77.6 years) were diagnosed with MCC during this 21-year period; 45% of patients had stage IIIB disease (pTNM) at diagnosis. All patients but one underwent local surgery, and lymphovascular invasion was detected in 7 cases. Eight patients received adjuvant therapy after surgery (radiation therapy in 5 cases and chemotherapy in 3). Six patients (54%) died of MCC (mean survival, 14.5 months). MCC is an uncommon malignant tumor with an annual incidence of around 0.18 to 0.41 cases per 100 000 inhabitants; this is similar to the rate of 0.29 to 0.32 cases per 100 000 inhabitants a year detected in our series. Results with avelumab, a drug recently approved for the treatment of metastatic MCC; have been promising., (Copyright © 2020 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To find out if the performance of the pharmaceutical expenditure between the most developed European countries come close more to a luxury good or a necessary good. To compare the pharmaceutical Spanish expenditure with the one of those countries., Design: Cross-sectional study., Setting: International. Europe., Participants: European countries members of the Organisation for Economic Co-operation and Development (OECD) and the European Union., Methods: The data come from the OECD reports and other papers with the same source of information. The majority of the data refer to year 2000. The relationship between pharmaceutical expenditure and other variables as expenditure on health, on research and development (R&D), and socio-demographic variables are analysed with correlation and multiple linear regression., Results: In both groups of countries, the Gross Domestic Product per capita (GDPPC) is positively and significantly correlated with the expenditure per capita on health (public and total) and on R&D, but not with pharmaceutical expenditure per capita (PhEPC). The pharmaceutical expenditure as part of total expenditure on health (PhE/TE) or as percentage of GDP (PhE/GDP), is negatively and significantly correlated with income (GDPPC). The regression model accepts as explicative variables of PhE/GDP: the income (negatively), the employment in health (negatively) and the PhEPC (positively). The PhEPC in Spain is situated in the average of the most developed European countries, and expressed as PhE/TE or as PhE/GDP is situated in the group of the countries with greater pharmaceutical expenditure, the majority of them with a lower GDPPC to the Spanish one., Conclusions: The performance of the pharmaceutical expenditure between the countries studied come close to a necessary good than to a luxury good. The PhEPC in Spain is situated in the average of these countries and, expressed as PhE/GDP or as PhE/TE, would be according to the Spanish income.

Objectives: To evaluate the validity of the information of bibliometric interest retrieved from MEDLINE and referred to the articles published by Atención Primaria journal from 1989 to 1995. To describe the presence of this journal and its evolution among the journals of its own thematic group (Family Practice) during the same period., Design: Retrospective descriptive study., Material: MEDLINE database on SilverPlatter, 1997 edition., Measurements: In a first step, all the documents published by the spanish journal during this period have been revised. Secondly, with a sample of 385 documents that comes from 24 issues selected at random, it has been analysed the indexing of the following fields: title in english (TI), original title (TO), authors (AU), bibliographic citation (SO), year of publication (PY), country of publication (CP) and type of publication (PT). The field institutional address of primary author (AD) will be studied exhaustively. The number of articles indexed coming from the different journals of the Family Practice group, and their evolution during the studied period were analysed, as the countries and languages of publication of these journals. The spanish journal has been compared with the rest of its thematic group in type of publications and type of studies (PT field)., Main Results: MEDLINE hasn't indexed 158 out of 1865 (8.47%) of the documents published by the journal from 1985 to 1995. This percentage becomes 4.04% when reply letters, that MEDLINE doesn't indexed, are not considered. MEDLINE offers the field AD for the papers published by the Spanish journal from 1990. From this moment on the field AD appears in 95% of the indexed documents. The 30% of the registers without the AD field, don't have institutional address in the original document. The institution or centre that MEDLINE cites firstly in the AD field, coincide with the one of the first author, in 99% of the cases. The number of authors is correct in all cases, even if in 3.37 +/- 1.8% there are typographical mistakes. TO, SO, PY and CP fields are always corrected. Nevertheless MEDLINE modifies in 66.7 +/- 4.7% of the documents the english title (TI field). The presence of the spanish journal in the Family Practice group has continuously increased in global terms from its inclusion in MEDLINE database, even if its relative contribution has stayed the same, around a 14%, in the course of the period analysed. There are differences between the spanish journal and the rest of the journals of its thematic group in type of publications and type of studies., Conclusions: The analysis of the 7 first years of the Atención Primaria indexing bring us to affirm that MEDLINE can be used to obtain valid information to describe some bibliometric aspects interesting for the scientific production, mainly coming from primary care spanish professionals, and published in this journal. Translations into english of the titles that appears in the english summary had to be improved. Institutional address had to be always and more clearly provided. The presence of the spanish journal among the journals of its thematic group is important (14%), even if its profile in type of publications and type of studies is significantly different.

Objectives: To describe the scientific production of primary care (PC) spanish professionals, during the current decade, using MEDLINE database. To identify which factors would explain the differences in the scientific production of PC professionals among Spanish autonomous communities (AACC)., Design: Retrospective, descriptive and analytical study. It has been designed a search strategy that will be used to retrieve this production from 1990 to 1997., Material: 1014 documents published in 44 journals during the analysed period., Measurements: Chronological evolution, authors, institutional addresses, geographic distribution, journals and thematic areas of this scientific production were analysed. The scientific production of any AACC was studied according to its socio-economic and human resources data. By uni and multivariant analysis we studied if the differences in PC professional's scientific production among the AACC are explained by socio-economic variables, available human resources and the degree of implementation of the new PC model in any AACC., Main Results: During the studied period, it was detected from MEDLINE an increase in the scientific production of the spanish PC professionals, either in articles published by Atención Primaria journal (73.7%), as in other Spanish journals (22.6%) and non-Spanish (3.7%) journals. In 71.9% of the documents the first author comes from a primary care centre. The main thematic areas treated in the articles are family practice and primary care topics, but a quarter of them tackled clinical topics. The only variable that explained the differences in the scientific production of these professionals among AACC was the bigger or lower increment of people covered by the new PC model in any AACC during the analysed period. This variable only explained 20% of the variability. The level of provincial income was significantly and inversely correlated with its scientific production., Conclusions: It can be set the suitability of MEDLINE for bibliometric studies of the scientific production of the spanish PC professionals. In global terms it has been detected an increment of this production. The degree of implementation of the new PC model in any AACC, has partially explained the differences in the scientific production of their PC professionals.

Background: To know the utilization of the screening mammography among women from 25 to 65 years old in an urban health zone, where there is not an specific screening program for breast cancer. To detect the demographic and risk determinants that are involved in the mammography screening use., Subjects and Methods: A sample of 1,240 women were interviewed consecutively as they visited their physician. Risk factors, sociodemographic variables and use of health services were analyzed. The associated variables with the use of mammography screening were determined by univariant analysis. A multiple logistic regression model was designed to identify the variables independently associated with the use of mammography screening., Results: The percentage of interviewed women who have completed at least one mammography screening in the last three years has been 10.2 +/- 3% (confidence level: 95%), 68.3% of them were under 50 years old. The variables independently associated with the use of mammography screening were: age (OR = 1.08); routine visit to the gynecologist (OR = 8.13); educational level (primary: OR = 2.44, secondary: OR = 3.66, university: OR = 7.43, no schooling: reference level); and knowledge about the benefits of mammography screening (OR = 6.15). Family history of breast cancer and the other risk factors were found not to be associated with the use of mammography screening., Conclusions: The use of mammography screening among women from 25 to 65 years is inadequate according to the age and other risk factors. Mammography screening among women with a family history of breast cancer and those over 50 years old is underused, so it would be recommended and their use increased for these women. But women under 40 years old without family history of breast cancer have to be dissuaded from undertaking such a screening.

Background: At school there are special circumstances of living together and a particular susceptibility, which favour the emergence of tuberculosis microepidemics. We report here the microepidemic occurred at a school among 9-year old children., Methods: After ruling out a possible familiar source in a child with pulmonary tuberculosis, we detected a case with high bacillar shedding in a female teacher and conducted a tuberculin search among children and teachers, initially outlining the theoretical groups at risk. Tuberculin positive children underwent chest-X-ray and when abnormalities were found, children were derived to the pediatrician for chemotherapy. All converters received secondary chemoprophylaxis and all non-respondents primary chemoprophylaxis., Results: The classroom where the teacher spent most of het time had a higher rate of converters (70%) than other classroom, where the index teacher spent only a partial time (40%; RR: 1.75; CI: 1.06-2.88) or the collective of teachers (45.4%; RR: 1.45; CI: 0.94-2.23). Three additional cases of secondary disease were detected, all of them children. The initial compliance with chemoprophylaxis was greater among (for) children (97.0%) than among teachers (41.6%). Among children there was one case of tuberculin conversion compared with three cases among teachers. No additional cases were detected; also, an abnormal rate of reactors outside the initially studied groups was also not detected., Conclusions: Our results somehow agree with those reported from other school outbreaks. To note the anergy and lack of symptoms in the index case and the suggestion to delineate the degree of spending hours together to identify groups with a higher theoretical risk of being infected. Thus, an unnecessary expense of resources and a social alarm would be avoided.

Objective: To know the coverage of the systematic program of hepatitis B vaccination in the population of 7th year primary school children (12 years old) in the city of Elche. To investigate the immune response to the vaccine, and the length of protection according to this response. To study the relationship between the immune response and other biological variables such as height, weight, Quetelet index and sex., Design: Cross-sectional study., Setting: In a school community., Participants: The first five students of 7th in all the official class lists (110) from each school (53) were selected. The immune response was studied in 427 students., Main Results: The 84.36 +/- 4 were correctly vaccinated (95 percent confidence level). A month after the booster dose, the antibodies HBs titres were quantified, considering levels of protection > or = 10 mU/ml. We found that Quetelet index and the antibody response were inversely correlated (p = 0.015). Sex was not a significant predictor of lack of detectable antibody response. 100% of correctly vaccinated children reached protective titres of antibodies, and 54% of them would be protected for 9 years or more., Conclusions: We consider the coverage satisfactory and excellent the seroprotection that this vaccine offers to these children. We suggest, to this population, a booster dose 10 years after the first vaccination.